Problem. The fire service remains one of the most hazardous industries in this country with its work-related injury rates and total annual costs exceeding those for most other occupations. Consistently over the years, musculoskeletal injuries are the major type of firefighter injury particularly in emergency medical service (EMS) operations, which are much more frequent than fire suppression. The tasks performed durlng EMS runs contain many of the same RIsk factors associated with musculoskeletal injury, and specifically back injury, in other occupations including: lifting, bending, pulling, twisting, awkward postures, and heavy workloads. Unfortunately, few studies have analyzed the biomechanical issues during emergency rescue operations. In a previous study funded by NIOSH, we identified and quantified the biomechanical and postural risk factors associated with emergency rescue tasks in the fire service. We are now in a position to design, develop, and evaluate targeted ergonomic interventions for this population of workers. Purpose. The purpose of this proposal is to develop and evaluate up to 10 ergonomic interventions that reduce biomechanical loads and are considered worthy of adoption for use by the workers who perform emergency medical/rescue (EMS) operations. We will be using a participatory ergonomic process, much like what has been advocated by NIOSH and others. Aims. The specific aims of the proposed research are: 1) In conjunction with fire service personnel, design specific equipment and work method interventions that address ergonomic concerns during EMS operations; 2) Develop and build equipment and refine work methods based on the design process; 3) Test equipment and refined work method interventions in a laboratory setting using simulated EMS tasks; refine and re-test equipment and methods as necessary based on participant feedback and biomechanical results; and 4) Implement and evaluate the interventions in the field to obtain usability and acceptability feedback from end users performing EMS operations. Methods. The intervention development and implementation process is comprised of four phases. In Phase 1, the design phase, we will conduct focus groups with firefighter/paramedics (the end users) to discuss ideas for equipment modifications and work method refinement based upon the intervention opportunities identified in our previous research. It is during this phase that the specific interventions will be identified. In Phase 2, the interventions that require the fabrication of equipment will be built and modifications to work methods refined. Phase 3 will test the modified equipment and work methods in a laboratory environment to quantify the effects on tissue loading. We will use a repeated measures experimental design to examine the relative effectiveness of the new interventions compared to the existing approaches in reducing biomechanical loads on the musculoskeletal system, and in particular the spine. In Phase 4, we will implement and evaluate the interventions in six field tests with firefighter/paramedics by collecting usage data after each emergency run and usability and acceptability data via written survey and group interview at the completion of each field test period. Product. The final product will be a set of up to 10 successful interventions that are biomechanically validated and superior to their existing counterparts and are judged to be worthy of adoption for use in the field by the end-user firefighter/paramedics.